Email
*
Child Date of birth
*
If they were premature, please identify their adjusted age. This assessment goes off of adjusted ages.
1. How would you describe your toddler’s muscle tone when you hold or touch them?
Floppy or soft
Tight or stiff
in between
2. My toddler can move into and out of standing using furniture for support.
True
False
3. My toddler is cruising (walking) along furniture, including around corners.
True
False
4. My toddler can let go and stand without support for a few seconds.
True
False
5. My toddler can take 10 or more steps on their own without support.
True
False
6. How would you describe your toddler’s walking pattern?
Launch mode: I need to keep my hands ready and surround them with soft furniture.
Toe walking: They walk on their tiptoes most of the time.
Controlled: They can stop on their own or with just a little help.
7. My toddler can squat down to pick something up without holding onto something for support.
True
False
8. My child could crawl up 2 steps on their hands and knees with supervision (but not physical support).
Yes
No
9. My child can stand up by themselves in the middle of the floor consistently.
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Yes
No
10. My child can maintain their balance in a kneeling position, when their hips are elevated off of their heels.
Yes
No
11. What would your child do if you rolled a ball to them while they were sitting alone?
They can't sit independently yet
They don't like to sit still
They would fall backwards or to the side and not catch the ball
They would likely catch the ball
12. Can your child roll a ball forward while sitting?
I'm not sure; we haven't tried
No
Yes
13. Can your child consistently throw a small ball that fits in their hand?
Yes
Not really; it often falls behind them before they get to throw it intentionally
No; they just try to put the ball in their mouth or are uninterested
14. Can your child open a hard, cardboard book by themself?
Yes
No
15. Is your child able to stir a spoon in a cup?
Yes
No
They haven't used a spoon before
16. If you handed your child a small, cylindrical container with small items resting at the bottom, what would they do?
Throw it away
Try to dump it outside down to empty it
Try to grab the items from the top with their fingers
17. Could your child place several small cubes in a cup or rounded container?
Yes
No
18. Can your child place a small item into a small opening container?
Yes
No
19. Can your child make a mark when attempting to scribble/color?
Yes, a line
Yes, a dot
No, it slides out of their hand
No, they just want to try to eat it
20. Can your child pick up 2 small toys in 1 hand and hold them for several seconds?
Yes
No
Thank you for taking our quiz. Is there anything specific that made you want to take this? Any other concerns that arose as you were taking this?